Provider Demographics
NPI:1558955542
Name:GALDAMEZ, LINDA JASMINE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JASMINE
Last Name:GALDAMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9728 57TH AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3521
Mailing Address - Country:US
Mailing Address - Phone:347-607-5444
Mailing Address - Fax:
Practice Address - Street 1:9728 57TH AVE APT 1D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3521
Practice Address - Country:US
Practice Address - Phone:347-607-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30567972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVQ40588XMedicaid